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Technology and Health Care is intended to serve as a forum for the presentation of original articles and technical notes, observing rigorous scientific standards. Furthermore, upon invitation, reviews, tutorials, discussion papers and minisymposia are featured.
The following types of contributions and areas are considered:
1. Original articles:
Technology development in medicine: New concepts, procedures and devices associated with the use of technology in medical research and clinical practice are presented to a readership with a widespread background in engineering and/or medicine.
Significance of medical technology and informatics for healthcare: The appropriateness, efficacy and usefulness deriving from the application of engineering methods, devices and informatics in medicine and with respect to public health are discussed.
2. Technical notes:
Short communications on novel technical developments with relevance for clinical medicine.
3. Reviews and tutorials (upon invitation only):
Tutorial and educational articles for persons with a primarily medical background on principles of engineering with particular significance for biomedical applications and vice versa are presented.
4. Minisymposia (upon invitation only):
Under the leadership of a Special Editor, controversial issues relating to healthcare are highlighted and discussed by various authors.
Abstract: Different rehabilitation programs are used to relieve dyspnea for hyper-inflated lung patients. In this study, a new approach, based on integrated changes in respiratory rate and pattern, for inspiratory muscles rehabilitation and training was examined utilizing noninvasive measurements of the two inspiratory muscles (rib cage inspiratory and neck inspiratory muscles) activity during controlled breathing in healthy subjects. Muscles activity was measured using electromyography, while subjects, breathed at different combinations of respiratory rate (6, 10, 16 breath per minutes) and inspiratory duty cycles (TI/Ttot). The results clearly show that both muscles were most active at the lowest evaluated respiratory rate, and…that alteration of the duty cycle at the lowest rate significantly (p < 0.05) changes their electrical activity. Breathing at low respiratory rate RR is recommended for hyper-inflated lung patients in order to improve their gas exchange, therefore, it is recommended for these patients to find their most effective combination of RR and TI/Ttot and to use control breathing to practice their breath at optimum combination.
Abstract: BACKGROUND: Stent placement can change the hemodynamics in basilar artery aneurysms. However, the effects of the stent placement can depend on the angle of vessel bifurcation. OBJECTIVE: The hemodynamics in and near the aneurysm are investigated for two angles of vessel bifurcation and two stent models. Some statistical indexes are calculated to evaluate the effects of the stent placements on the possibility of aneurysm rupture. METHODS: Computational fluid dynamics simulations and phantom model experiments are performed. The angle between the basilar and posterior cerebral arteries is set to 90 and 135 degrees.…The single stent and Y stent models are tested in addition to the case without stent placement. RESULTS: The velocity in the aneurysm in the Y stent case is smaller than that in the no stent and single stent cases when the angle is 135 degrees. High OSI and low AFI areas often appear at the same locations, and the area is larger in the single stent case than in the no stent and Y stent cases. CONCLUSIONS: The Y stent placement promotes hemostasis and thrombosis in the basilar artery aneurysm, whereas the single stent placement can enhance the growth and rupture.
Abstract: BACKGROUND: Hemodynamic factors play important roles in aneurysm recurrence after endovascular treatment. OBJECTIVE: Predicting the risk of recurrence by hemodynamic analysis using an untreated aneurysm model is important because such prediction is required before treatment. METHODS: We retrospectively analyzed hemodynamic factors associated with aneurysm recurrence from pretreatment models of five recurrent and five stable posterior communicating artery (Pcom) aneurysms with no significant differences in aneurysm volume, coil packing density, or sizes of the dome, neck, or Pcom. Hemodynamic factors of velocity ratio, flow rate, pressure ratio, and wall shear stress were investigated. RESULTS:…Among the hemodynamic factors investigated, velocity ratio and flow rate of the Pcom showed significant differences between the recurrence group and stable group (0.630 ± 0.062 and 0.926 ± 0.051, P = 0.016; 56.4 ± 8.9 and 121.6 ± 6.7, P = 0.008, respectively). CONCLUSIONS: Our results suggest that hemodynamic factors may be associated with aneurysm recurrence among Pcom aneurysms. Velocity and flow rate in the Pcom may be a pretreatment prognostic factor for aneurysm recurrence after endovascular treatment.
Abstract: OBJECTIVE: To compare the dosimetric and efficiency differences for left-sided breast cancer radiotherapy after breast-conserving surgery among three different planning techniques: double-arc volumetric-modulate arc therapy (VMAT), step-shoot intensity-modulated radiotherapy (sIMRT) and three-dimensional conformal radiation therapy (3D-CRT). MATERIALS AND METHODS: A total of 17 female patients with left-sided breast cancer who underwent breast-conserving surgery were selected; the prescription doses were 50 Gy in 25 fractions. For every patient VMAT, sIMRT and 3D-CRT plans were generated within the Monaco treatment planning system for an Axesse™ accelerator equipped with the Agility MLC. The Conformity Index (CI), the Homogeneity Index (HI),…the dose volume histogram (DVH) parameters for the organs at risk and the delivery efficiency were evaluated. RESULTS: The VMAT plans showed on average higher CI of PTV (0.77 ± 0.03) than both sIMRT (0.68 ± 0.02) and 3D-CRT (0.55 ± 0.04) plans (P < 0.05). The HI values in the VMAT, sIMRT and 3D-CRT plans were 0.10 ± 0.01 0.09 ± 0.01 and 0.13 ± 0.01 (P > 0.05), respectively, and the differences among the three techniques were not statistically significant. In the ipsilateral lung, the VMAT plans showed lower D mean , V 30 , V 20 , and V 10 than the sIMRT and 3D-CRT (P < 0.05); however, there was no significant difference in V 5 . In the heart, the VMAT plans had lower V 30 and V 20 than the sIMRT and 3D-CRT plans (P < 0.05), but there was no significant difference in the D mean and V 5 . In the contralateral lung, the VMAT plans showed higher D mean and V 5 than sIMRT and 3D-CRT (P < 0.05). In the contralateral breast, the VMAT plans had a higher V 5 than the sIMRT and 3D-CRT plans (P < 0.05). The VMAT plans had higher MU’s than sIMRT and 3D-CRT, while the treatment times were lower than that of sIMRT. CONCLUSION: For left-sided breast cancer radiotherapy after breast-conserving surgery, the VMAT plans had a better CI than the sIMRT and 3D-CRT plans. The VMAT and the sIMRT plans had better HI than the 3D-CRT plans, but no significant difference was observed between VMAT and sIMRT.
Abstract: OBJECTIVE: This study was designed to evaluate the significance of transperineal two-dimensional ultrasound in the diagnosis and classification of female stress urinary incontinence (SUI). METHODS: A total of 87 preoperative SUI patients (group A) from the Department of Gynecology of Peking University People’s Hospital were included into this study. These patients were further divided into two groups (groups A1 and A2) according to the severity of their disease. In addition, during the same period, 72 age-matched women without SUI were enrolled into this study and assigned as the control group (group B). Through transperineal two-dimensional ultrasound…technique, detrusor wall thickness (DWT) was measured in the resting state, the bladder neck descent (BND) was measured under the maximal valsalva maneuver, the proximal urethral rotation angle (α angle) and posterior vesicourethral angle (β angle) were measured, and the formation of the funnel-shaped urethra was observed. RESULTS: Under the resting state, differences in DWT between groups A and B, as well as between groups A1 and A2, were not statistically significant (P > 0.05). The BND, α and β angles were significantly larger in group A than in group B under the maximal Valsalva maneuver; and the differences were statistically significant (P < 0.05). The formation rate of the funnel-shaped urethra was significantly higher in group A (94%) than in group B (3%), and the difference was statistically significant; while the difference between groups A1 and A2 was not statistically significant (P > 0.05). CONCLUSION: Transperineal two-dimensional ultrasound can play an assistant role in the diagnosis of female SUI. However, its role in the assessment of the severity of SUI remains to be studied.
Abstract: BACKGROUND AND OBJETIVE: A stroke patient with hemiplegic gait is generally described as being slow and asymmetric. Body weight-supported treadmill training and backward gait training are recent additions to therapeutic gait trainings that may help improve gait in stroke patient with hemiplegic gait. Therefore, we examined the effect of progressive backward body weight-supported treadmill training on gait in chronic stroke patients with hemiplegic gait. METHODS: Thirty subjects were divided to the experimental and control groups. The experimental group consisted of 15 patients and underwent progressive backward body weight-supported treadmill training. The control group consisted of 15…patients and underwent general treadmill gait training five times per week, for a total of four weeks. The OptoGait was used to analyze gait kinematics, and the dynamic gait index (DGI) and results of the 6-minute walk test were used as the clinical evaluation indicators. A follow-up test was carried out four weeks later to examine persistence of exercise effects. RESULTS: The experimental group showed statistically significant results in all dependent variables week four compared to the control group. However, until the eighth week, only the dependent variables, of affected step length (ASL), stride length (SL), and DGI differed significantly between the two groups. CONCLUSION: This study verified that progressive bodyweight-supported treadmill training had a positive influence on the temporospatial characteristics of gait and clinical gait evaluation index in chronic stroke patients.
Abstract: BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD), as one of the most common neurological disorders in children and adolescents, is characterized by decentralization, slow learning, distraction and hyperactivity. Studies have shown that in addition to medication, neurofeedback training can also be used to partially control the brain activity of these patients. METHODS: In this study, using the brain signals processing before and after the treatment in 10 children treated by neurofeedback, the changes were evaluated by non-parametric statistical analysis and impact of neurofeedback on brain frequency bands was investigated. Finally, the results were compared with the protocols introduced in…this paper and before researches. RESULTS: The results of Kruskal-Wallis test showed an approximately significant increase in the relative power of gamma and an approximately significant reduction in the ratio of relative power of alpha/beta. CONCLUSIONS: It represents the emotional response, elicited by the successful learning and diminished ratio of slow learning to active learning respectively.
Keywords: Attention-deficit/hyperactivity disorder, Electroencephalography, Kruskal-Wallis test, neurofeedback, power spectral density
Abstract: An arteriovenous graft (AVG) has a higher patency rate in stenosis progression at the venous anastomosis site, which causes coexisting inflow and outflow stenoses. This leads to increases in blood pressure, flow velocity, and flow resistance, resulting in hemodialysis (HD) vascular access dysfunction from early clots and thrombosis to the progression of coexisting stenoses. To prevent vascular access complications such as inflow or outflow stenoses, this study proposes a novel examination method in an experimental AVG system using a substitution-rate based screening model. In our practical measurements, we found that inflow and outflow channeled through a narrowed access indicated both…pressure and resistance differences as the degree of stenosis (DOS) gradually increased. A substitution-rate matrix was conducted to replace bilateral pressure variations, while a transition probability matrix was calculated. Differences in transition probabilities were then used to distinguish between normal conditions and flow instabilities using the distance estimation method. The joint probability decayed from < 0.81 to 0.00 could be specified to identify the progression in stenosis levels from a DOS% = 50.0–95.0%. Average joint probabilities were found to be inversely related with the DOS using a non-linear regression (R> 2 0.90). Hence, the joint probability could be specified as a critical threshold, < 0.81, to identify the severity stenosis level, DOS% ⩾ 70%, in the assessment of coexisting inflow and outflow stenoses. Experimental results suggest that the proposed model is superior to hemodynamic analysis and traditional intelligent method, and can be used for dysfunction screening during HD treatment.
Keywords: Arteriovenous graft, patency rate, substitution rate, transition probability matrix
Abstract: This paper aims to analyze possible next generation of networked radio frequency identification (NGN-RFID) system for customer relationship management (CRM) in healthcare industries. Customer relationship and its management techniques in a specific healthcare industry are considered in this development. The key objective of using NGN-RFID scheme is to enhance the handling of patients’ data to improve the CRM efficiency in healthcare industries. The proposed NGN-RFID system is one of the valid points to improve the ability of CRM by analyzing different prior and current traditional approaches. The legacy of customer relationship management will be improved by using this modern NGN-RFID…technology without affecting the novelty.
Keywords: Next generation network, RFID, sensors, customer relationship management, e-Health
Abstract: BACKGROUND: Issues in patient safety and nursing efficiency have long been of concern. Advancing the role of nursing informatics is seen as the best way to address this. OBJECTIVES: The aim of this study was to determine if the use, outcomes and satisfaction with a nursing information system (NIS) improved patient safety and the quality of nursing care in a hospital in Taiwan. METHOD: This study adopts a quasi-experimental design. Nurses and patients were surveyed by questionnaire and data retrieval before and after the implementation of NIS in terms of blood drawing, nursing process, drug administration,…bar code scanning, shift handover, and information and communication integration. RESULTS: Physiologic values were easier to read and interpret; it took less time to complete electronic records (3.7 vs. 9.1 min); the number of errors in drug administration was reduced (0.08% vs. 0.39%); bar codes reduced the number of errors in blood drawing (0 vs. 10) and transportation of specimens (0 vs. 0.42%); satisfaction with electronic shift handover increased significantly; there was a reduction in nursing turnover (14.9% vs. 16%); patient satisfaction increased significantly (3.46 vs. 3.34). CONCLUSIONS: Introduction of NIS improved patient safety and nursing efficiency and increased nurse and patient satisfaction. Medical organizations must continually improve the nursing information system if they are to provide patients with high quality service in a competitive environment.
Keywords: Nursing information system, patient safety, nurse efficiency, bar codes, shift handover